Procedures for a Transpyloric Feeding Tube Inserted Into Newborns and Infants: A Systematic Review.

BACKGROUND: Enteral feeding by a transpyloric tube in critically ill infants is indicated when there is a failure in gastric feeding. However, there is a wide variability regarding the insertion technique. PURPOSE: To perform a systematic review of the methods for inserting a transpyloric feeding tube in newborns and infants. DATA SOURCES: Nine databases, without date or language restrictions, accessed in September 2021. STUDY SELECTION: A systematic review of experimental and nonexperimental studies, according to the "Patient/problem; Intervention; Comparison; Outcome" strategy and the "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" guidelines. The clinical question was about the measurement and insertion techniques, as well as the success rates of properly placing a transpyloric tube in newborns and infants. DATA EXTRACTION: Two authors (N.M.Q. and J.F.S.) analyzed 6 observational descriptive prospective studies, all of them published in peer-reviewed indexed medical journals and one in the official journal of the National Association of Neonatal Nurses. RESULTS: The success rate varied between 70% and 100%. There was an important variability in the type of tube, measurement method, and insertion techniques. It was found that the most common strategies to achieve proper positioning were glabella-calcaneal measurements, gastric air insufflation, and right lateral decubitus. IMPLICATIONS FOR PRACTICE: A transpyloric catheter insertion protocol needs to be established in each neonatal unit, according to the literature findings. IMPLICATIONS FOR RESEARCH: Randomized controlled studies that evaluate the gastric air insufflation technique and other adjuvant measures could elucidate the knowledge gap concerning the correct positioning of transpyloric tubing in newborns and infants.

Adaptation of an instrument to classify neonatal patients into care categories.

OBJECTIVE: To adapt and validate a patient classification instrument for neonatal units. METHOD: Methodological study, with adaptation of the Pediatric Patients Classification Instrument for neonatal patients. After content validation by judges, the instrument was tested for reliability, applied to 33 neonates by two nurses, simultaneously. To assess the agreement among nurses regarding the scores of each patient on the classification scale, an intraclass agreement coefficient was applied. To assess the agreement regarding the classification in care categories, the weighted Kappa coefficient was calculated. RESULTS: The adapted instrument consisted of a total of nine indicators, with three care categories: high dependence on care, semi-intensive care and intensive care. The Content Validity Index varied between 0.85 and 0.92 for items of the instrument. The intraclass agreement was 0.87 and the weighted Kappa for care categories was 0.56. CONCLUSION: An instrument that allows neonatal patients to be classified into care categories, with satisfactory reliability was validated to support the dimensioning of the nursing team.

Adaptation of an instrument to classify neonatal patients into care categories / Adaptación de un instrumento para clasificar pacientes neonatales en categorías de cuidados / Adaptação de instrumento para classificação de pacientes neonatais em categorias de cuidados

ABSTRACT Objective: To adapt and validate a patient classification instrument for neonatal units. Method: Methodological study, with adaptation of the Pediatric Patients Classification Instrument for neonatal patients. After content validation by judges, the instrument was tested for reliability, applied to 33 neonates by two nurses, simultaneously. To assess the agreement among nurses regarding the scores of each patient on the classification scale, an intraclass agreement coefficient was applied. To assess the agreement regarding the classification in care categories, the weighted Kappa coefficient was calculated. Results: The adapted instrument consisted of a total of nine indicators, with three care categories: high dependence on care, semi-intensive care and intensive care. The Content Validity Index varied between 0.85 and 0.92 for items of the instrument. The intraclass agreement was 0.87 and the weighted Kappa for care categories was 0.56. Conclusion: An instrument that allows neonatal patients to be classified into care categories, with satisfactory reliability was validated to support the dimensioning of the nursing team.

RESUMEN Objetivo: Adaptar y validar un instrumento para clasificar pacientes de unidades neonatales. Método: Se trata de un estudio metodológico, con la adaptación del Instrumento de Clasificación de Pacientes Pediátricos para pacientes neonatales. Después de la validación de contenido llevada a cabo por jueces, se testó el instrumento en cuanto a la fiabilidad, con dos enfermeras que lo aplicaron simultáneamente en 33 neonatos. Para evaluar la concordancia entre las enfermeras con respecto a las puntuaciones de cada paciente en la escala de clasificación, se aplicó un coeficiente de concordancia intraclase. Para sopesar la concordancia en la clasificación de las categorías de atención, se calculó el coeficiente Kappa ponderado. Resultados: El instrumento adaptado constaba de nueve indicadores, con tres categorías de cuidados: dependencia alta de cuidados, cuidados intermedios y cuidados intensivos. El Índice de Validez del Contenido oscilaba entre 0,85 y 0,92 para los elementos del instrumento. La concordancia intraclase era 0,87 y el Kappa ponderado para las categorías de atención, 0,56. Conclusión: Se validó un instrumento para clasificar a los pacientes neonatales en categorías de atención, con una fiabilidad satisfactoria para subvencionar el dimensionamiento del personal de enfermería.

RESUMO Objetivo: Adaptar e validar instrumento de classificação de pacientes para unidades neonatais. Método: Estudo metodológico, com adaptação do Instrumento de Classificação de Pacientes Pediátricos para pacientes neonatais. Após a validação de conteúdo por juízes, foi realizado teste do instrumento quanto à confiabilidade, com aplicação em 33 neonatos por duas enfermeiras, de forma simultânea. Para avaliar a concordância entre as enfermeiras quanto aos escores de cada paciente na escala de classificação, aplicou-se coeficiente de concordância intraclasse. Para avaliar a concordância quanto à classificação em categorias de cuidado, foi calculado o coeficiente Kappa ponderado. Resultados: O instrumento adaptado ficou constituído por nove indicadores, com três categorias de cuidado: alta dependência de cuidados, cuidados semi-intensivos e cuidados intensivos. O Índice de Validade de Conteúdo variou entre 0,85 e 0,92 para itens do instrumento. A concordância intraclasse foi de 0,87 e o Kappa ponderado para as categorias de cuidado foi de 0,56. Conclusão: Foi validado um instrumento que permite classificar pacientes neonatais em categorias de cuidados, com confiabilidade satisfatória, para subsidiar o dimensionamento de pessoal de enfermagem.